{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["McCoy IE"],"funding":["NIDDK NIH HHS","National Institutes of Health"],"pagination":["2114-2122"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC8973200"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["96(8)"],"pubmed_abstract":["<h4>Objective</h4>To assess present angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) use among patients with proteinuric chronic kidney disease (CKD) and examine barriers limiting this guideline-concordant care.<h4>Patients and methods</h4>Using a nationwide database containing patient-level claims and integrated clinical information, we examined current ACEI/ARB prescriptions on the index date (April 15, 2017) and prior ACEI/ARB use in 41,743 insured adults with proteinuric CKD. Using multivariable logistic regression, we estimated adjusted associations between current ACEI/ARB use and putative barriers including past acute kidney injury (AKI), hyperkalemia, advanced CKD, and lack of nephrology care.<h4>Results</h4>Only 49% (n=20,641) of patients had an active ACEI/ARB prescription on the index date, but 87% (n=36,199) had been previously prescribed an ACEI/ARB. Use was lower in patients with past AKI, hyperkalemia, CKD stages 4 or 5, and a lack of nephrology care (adjusted odds ratios were 0.61 [95% CI, 0.58 to 0.64], 0.76 [95% CI, 0.72 to 0.80], 0.48 [95% CI, 0.45 to 0.51], and 0.85 [95% CI, 0.81 to 0.89], respectively).<h4>Conclusion</h4>Discontinuing, rather than never initiating, ACEI/ARB treatment limits guideline-concordant care in proteinuric CKD. Past AKI, hyperkalemia, advanced CKD, and lack of nephrology care were associated with lower use of ACEIs/ARBs, but these putative barriers may in many instances be inappropriate (AKI and advanced CKD) or modifiable (hyperkalemia and lack of nephrology care)."],"journal":["Mayo Clinic proceedings"],"pubmed_title":["Barriers to ACEI/ARB Use in Proteinuric Chronic Kidney Disease: An Observational Study."],"pmcid":["PMC8973200"],"funding_grant_id":["2K24DK085446","5T32DK007357","K24 DK085446","T32 DK007357"],"pubmed_authors":["Han J","Montez-Rath ME","Chertow GM","McCoy IE"],"additional_accession":[]},"is_claimable":false,"name":"Barriers to ACEI/ARB Use in Proteinuric Chronic Kidney Disease: An Observational Study.","description":"<h4>Objective</h4>To assess present angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) use among patients with proteinuric chronic kidney disease (CKD) and examine barriers limiting this guideline-concordant care.<h4>Patients and methods</h4>Using a nationwide database containing patient-level claims and integrated clinical information, we examined current ACEI/ARB prescriptions on the index date (April 15, 2017) and prior ACEI/ARB use in 41,743 insured adults with proteinuric CKD. Using multivariable logistic regression, we estimated adjusted associations between current ACEI/ARB use and putative barriers including past acute kidney injury (AKI), hyperkalemia, advanced CKD, and lack of nephrology care.<h4>Results</h4>Only 49% (n=20,641) of patients had an active ACEI/ARB prescription on the index date, but 87% (n=36,199) had been previously prescribed an ACEI/ARB. Use was lower in patients with past AKI, hyperkalemia, CKD stages 4 or 5, and a lack of nephrology care (adjusted odds ratios were 0.61 [95% CI, 0.58 to 0.64], 0.76 [95% CI, 0.72 to 0.80], 0.48 [95% CI, 0.45 to 0.51], and 0.85 [95% CI, 0.81 to 0.89], respectively).<h4>Conclusion</h4>Discontinuing, rather than never initiating, ACEI/ARB treatment limits guideline-concordant care in proteinuric CKD. Past AKI, hyperkalemia, advanced CKD, and lack of nephrology care were associated with lower use of ACEIs/ARBs, but these putative barriers may in many instances be inappropriate (AKI and advanced CKD) or modifiable (hyperkalemia and lack of nephrology care).","dates":{"release":"2021-01-01T00:00:00Z","publication":"2021 Aug","modification":"2026-05-09T19:30:27.96Z","creation":"2025-04-19T22:48:56.657Z"},"accession":"S-EPMC8973200","cross_references":{"pubmed":["33952396"],"doi":["10.1016/j.mayocp.2020.12.038"]}}